mother holding baby, kissing cheek

A small, pink journal became a necessary part of 27-year-old Solana Wenzel's self-care practices after giving birth to her fourth child in May.

"The way I was feeling right after [giving birth], and the way I progressed, and how I made the changes—that little book alone did so much for me " says Wenzel.

The journal was one of 12 items included in her Fourth Phase Birth Box, a care package curated to suit the physical and emotional needs of those who've just given birth. The boxes, sorted by birthing method, include items like a nipple salve, lactation tea, postpartum sanitary pads, and a belly wrap for back and core support.

Before launching the brand in March of 2021, co-founders Nana Eyeson-Akiwowo and Marcia Cole spent nine months conducting focus groups and consulting with moms, birthing professionals, and other medical specialists, to determine what items would be most essential during the postpartum period. The intention behind Fourth Phase is to create dedicated time for new parents to take for themselves, which Eyeson-Akiwowo notes becomes especially difficult when caring for a newborn.

"They're running on empty, and giving and giving," she says of new moms. "And they have nothing left for themselves, and then the whole thing blows up."

Fourth Phase's commitment to maternal health and wellness extends beyond afterbirth boxes. Eyeson-Akiwowo and Cole had been petitioning for the term "fourth trimester" to be added to all dictionaries. Their efforts began online in May 2021, with the women collecting signatures for their campaign and tagging the world's most respected dictionaries in social media posts. In October, Merriam-Webster announced "fourth trimester" made its list of new added words, defined as "the three month period immediately following giving birth in which the mother typically recovers from childbirth and adjusts to caring for her infant."

Why Adding Fourth Trimester to the Dictionary Matters

The fourth trimester is a period marked with hormonal changes, adjustment to new familial responsibilities, and overwhelming emotions as new parents seek to manage both stress and expectations, says Kimberly Harper, RN, with the University of North Carolina at Chapel Hill's 4th Trimester Project. "Motherhood should not mean risking your health, happiness, or life," says Harper, quoting a mantra from the 4th Trimester project.

Support for new parents, she adds, looks like holistic, wraparound care, to set them up for success both physically and emotionally. Harper and other birthing professionals say adding the term "fourth trimester" to all dictionaries assists in ongoing efforts to better support birthing people in their respective postpartum journeys.

"If someone were to Google 'the fourth trimester,' if they were able to have that definition come up for them and be as accessible as possible, I think that a lot of people would feel less alone in that life stage," says Davinah Simmons, owner of Rooted Birth Doula Services in Seattle. "And I think there would be some validation when you think of this from a capitalistic perspective. If something is in the dictionary, then it has meaning to certain dominate cultures."

Support in the Fourth Trimester Can Make All the Difference

The fourth trimester is still not a very well-known term, but it should be, notes Tia Welsh, M.D., MPH, an OB-GYN based in Ridgewood, New Jersey.

To optimize postpartum care, Dr. Welsh believes new parents should come back in for their post-birth appointment at three weeks, which is something she plans to advocate for in her new role as chair of women's health for Valley Medical Group.

The traditional six- to eight-week timeline lies on the latter end of the fourth trimester, and doctors are missing crucial opportunities to check in with their patients and monitor how they're adjusting, adds Dr. Welsh.

This aligns with new guidance from the American College of Obstetricians and Gynecologists that encourages postpartum care to be "an ongoing process, rather than a single encounter" and "should include a full assessment of physical, social, and psychological well-being."

Efforts to place importance on healing and support in the fourth trimester come at a time when the U.S. is tackling a maternal health crisis, which is disproportionately affecting Black and Indigenous women. Also impacting postpartum care is access to paid maternity/paternity leave, says Harper. About 1 in 4 employed women in the U.S. return to work within 10 days of giving birth, many having to minimize their own health needs in order to provide for their family, she says.

Families have also been taught a cultural norm that after the six-week mark postpartum, "the bumper lanes are off," says Simmons.

"It's like, you are released back into the world, and you can have sex, you can move your body and exercise," she says. "It's a way that we do families a disservice from getting adequate rest and getting adequate support during those first three months of a baby's life."

New moms who've enjoyed the offerings of the Fourth Phase Boxes say they're thankful that Eyeson-Akiwowo and Cole chose to support them in this way, with a reminder of the importance of self-care in the postpartum process. That includes Genevieve Alcinay, a mother who was gifted a Fourth Phase Box right before the birth of her twins in April.

One of her favorite items was the postpartum full-coverage underwear. Instead of the stark-white, standard ones she received from the hospital, the Fourth Phase panties were all-black. It was this "little touch of luxury"—something as simple as swapping out underwear—that Alcinay says made her fourth trimester brighter.

"It was beyond the product," she says. "It was knowing that other women needed this product, so someone developed it because they identified that we deserve to feel good, even in this process."


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